Finding a “New Orientation” in Mexican Public Health: the Servicio Médico-Social

March 29, 2018

Steve Server
Chicago, Illinois, United States

The Palace of the Inquisition,the site of the old National Medical School, Plaza Santo Domingo, Mexico City

In the 1935-1936 issue of the Mexican Public Health Department’s newsletter, Salubridad, the newly-minted Chief of the Department, Doctor and General José Siurob, offered a vision for the “new orientation for the public health services.”1 He announced that the department would be entering “a new era of social action, consequent with the postulates and tendencies of an eminently revolutionary Government and placed at the service of the lively forces of the country.”2 Siurob noted that the newly-socially-conscious Department would have to attend to the “actual social conditions” of Mexico, after having arrived “at the firm conviction that more than half of the labor that it perform[ed], rest[ed] in the work of education, and the rest…to economic betterment of the population and to the technical work that, with the limited resources that the Department posess[ed],” would clear a path “slowly, but firmly, toward the conquest of its high conclusion.”3 Clearly, General Siurob was enthusiastic about the changes in the offing at the Department.

In announcing his “new orientation,” Siurob was advocating for a rupture from the current trajectory of public health practice. According to one prominent official, cities were filled with “egotistical and disillusioned doctors,” while the rest of the nation, especially the rural hamlets, “labored in the completest social, scientific, and cultural isolation.”4 Consequently, public health officials sought out a new model that treated the sick not as biological systems, but rather as individuals who were inextricably bound within a skein of socioeconomic relations that required careful hands to untangle. They sought out a medicine that broke down the walls of the old medical establishment, embodied by the impenetrable Baroque walls of the medical school at the Palacio de la Inquisición. They searched for a model that valued social relations as much as scientific truth.

Socially-minded physicians recognized that doctors had set the stage for the health disparities that they observed, and it was these established professionals whose noblesse oblige required that they correct the mistakes of the earlier era. In a 1934 issue of the well-regarded medical journal, the Gaceta Médica de México, the venerable physician—and onetime Rector of the National University – Dr. Alfonso Pruneda described his concern about the values of the profession:

The same progress which science and art have reached has often obligated medicine to forget the personhood of the patient, with the force of studying the patient with such thoroughness, making them forget the concept of the “sick man,” of the individual who suffers throughout their whole being with great danger that with the help given to it, with the force of being so scientific, stops being “human.”5

The scientific professionalization of medicine during the preceding years had caused the art of healing to lose its soul. The only way to redeem medicine was to give the aged body of medicine an injection of values. The readers of the Gaceta “must not forget that [our young physicians] and even more, our medical students, need to know the art of proper conduct with the sick.”6 Clinicians now had a responsibility to change the profession for the better by focusing on the training of the next generation. The future of medical practice – and of the future moral standing of the nation – was at stake.

In 1936, Mexico’s curative was administered. The servicio médico-social (SMS) was a social service program that required medical students at the Universidad Nacional Autónoma de Mexico (UNAM) to spend a period of approximately six months doing medical service, basic sanitary oversight, and record-taking in a rural Mexican village. From the medical faculty, situated a few blocks from the Zócalo, the heart of Mexico City, students would leave the metropolis to familiarize themselves with the true heart of Mexico: its rural denizens. Rural dwellers suffered crippling poverty and lacked access to affordable medical care and basic knowledge of hygiene. The SMS was an ideal opportunity to provide a low-cost, low-footprint curative to this profound and persistent problem of social welfare and infrastructure in a nation whose majority lived in rural environs, while inculcating a spirit of civic mindedness among the nation’s future physicians.

At the time of publication of his “New Orientation” piece, Doctor Siurob’s counterpart at UNAM’s Medical Faculty was Dr. Gustavo Baz Prada. Baz’ signature accomplishment was his role as father of the SMS. In a 1970 interview, Dr. Baz claimed that the SMS arose as an epiphany:

I was under an umbrella in Acapulco, reading a novel, when I stopped to think about my modest history… remembering my life in the Revolution, in which I had seen the populace of the Republic deprived of medical care, it occurred to me that I could establish the servicio de los pasantes de medicina as something mandatory. To require them, over the course of a year, to go to places that had never had a doctor before.7

As University history has it, Baz presented the program to the rector of UNAM, Luis Chico Goerne, on December 2, 1935. Over the next few months, funding trickled in from the DSP, UNAM, and from the Secretary of Communications, until finally, in August and September of the following year, the first set of medical students left Mexico City for Mexico’s countless rural spots.

Despite this version of the timeline, which celebrates Dr. Baz and the important ethical role of established physicians, the specific origins of the program remain somewhat more complicated than the myth of the heroic physician. Indeed, despite Pruneda’s fears that young doctors lacked the moral ballast to complete their duty, the SMS seems to have emanated from the social enthusiasm of medical students themselves.

Medical students had been interested in engagement with the community outside of the walls of the Palacio de la Inquisición in years leading up to the SMS’ rollout. Prior to Baz’ tenure, which began in late 1935, students went on public health mission trips, referred to as “viajes de higiene.” The budding physicians seem to have made quite a favorable impression. In late September and early October of 1934, the Facultad received letters from doctors eager to offer praise for the socially-conscious students. Dr. Alberto Cancino of Soconusco, Chiapas remarked at the “magnificent impression” left by the visiting students throughout the state, “as much as by their behavior in social acts as by their particular interest in learning about Ochocerciasis.”8 The grateful and impressed alumnus of the Faculty added “in all sincerity and with unanimity” that a round of applause was granted, even many kilometers away.9 Dr. Clemente Carerra, a sanitary delegate to the Federal Border patrol, wrote to the Faculty – ostensibly about the same viaje to the Guatemalan border in Chiapas – that the students had displayed “correct and measured” behavior, “painstaking dedication and laudable effort and interest in the problems and sanitary and hygienic issues of the region.”10 By spending time with this group of students, the entire community had “experienced a profound satisfaction and admiration toward their beloved and unforgettable” alma mater.11 He concluded the letter with a note of hearty congratulations. And in July of 1936 – a few months before the first big departure of students – the Society for the Students of the Facultad sent a letter to Dr. Baz, informing him that they would be organizing a National Singers Grand Prize for Workers, Employees, and Students, “with the goal of identifying the studious youth with the working youth in different proletarian branches.”12 With the help of Dr. Baz behind their program, they hoped to achieve the “greatest resonance possible, a resonance that would redound as a benefit to the good name of the student of this Faculty.”13 Earnest and ad-hoc social engagement by students passed through Baz’ office, and immediately became amplified to the national interest.

Baz was thus not the father of the SMS, but was its obstetrician. Notwithstanding official mythologizing, the origins of the SMS seem to have been as complex as the politics of the post-Revolutionary period itself. The plans of eager, socially-engaged students had firmly crystalized into a state-sponsored, medical school-approved program. By means of Baz’ close work with Federal-level cabinet departments, such as the Department of Public Health, student engagement was institutionalized and made part of the state’s overall “new orientation” toward medical practice, which revalorized the patient as a social animal. All that was left for the state was to open the large wooden doors of the medical school, and send the budding clinicians on their way.

STEVE SERVER is an MD/PhD student at the University of Chicago, a member of the Committee on the Conceptual and Historical Studies of Science, the Department of History, and the Pritzker School of Medicine. He graduated from the University of Oxford in 2015 with an MSc in the History of Science, Medicine, and Technology. His research focuses on the relationship between political ideology and medical practice, with a particular interest in twentieth-century Latin America.